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Nitric oxide activity in childhood hypertension
C D Goonasekera1, V Shah, D D Rees
1Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London.
Objectives:
To investigate nitric oxide (NO) activity in childhood hypertension using nitrite and nitrate (NOx) concentrations in plasma as an index of nitric oxide generation.
Design:
Cross sectional study.
Setting:
Tertiary care paediatric centre and district general hospitals in the UK.
Patients:
Children attending the above centre for treatment of hypertension. The control subjects were normotensive healthy children attending district general hospitals for minor medical and surgical disorders.
Interventions:
None.
Main Outcome Measures:
Plasma (P) and urinary (U) NOx concentrations, blood pressure, and glomerular filtration rate.
Results:
Sixteen normal children (mean age 6.9 years), 13 children with renovascular hypertension (mean age 7.8 years), and 25 children with hypertension associated with renal parenchymal disease (mean age 10.7 years) were studied. Mean (SD) PNOx values of children with hypertension with renovascular disease (15.3 (11.4) mumol/l) and renal parenchymal disease (18.3 (11.4) mumol/l) were significantly above that of normal children (11.9 (5.9) mumol/l) after accounting for age and glomerular filtration rate influences. Higher concentrations of PNOx in normal children were associated with younger age, but not in the children with hypertension. Higher PNOx concentrations were also associated with a lower glomerular filtration rate in normal children and children with hypertension with renal parenchymal disease, but not in the children with hypertension with renovascular disease. UNOx excretion expressed as a ratio against urine creatinine (Ucreat) excretion was not statistically different among the study groups.
Conclusions:
PNOx is increased in children with hypertension even after statistical elimination of the glomerular filtration rate and age influences. This suggests a normal or increased NO synthase activity in childhood hypertension in contrast with adults with hypertension in whom it is described as reduced.